{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:42:09Z","timestamp":1785768129288,"version":"3.56.0"},"reference-count":15,"publisher":"Scientific Scholar","content-domain":{"domain":["ijmr.org.in"],"crossmark-restriction":true},"short-container-title":["Indian J Med Res"],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>The risk-treatment paradox (RTP) has not been studied in very high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). We aimed to describe the cohort of very high-risk NSTE-ACS patients, analyse the impact of RTP on outcomes, and identify subgroups of patients who derive the greatest benefit from immediate invasive coronary angiography (ICA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective analysis included 340 patients diagnosed with NSTE-ACS who met at least one of the established criteria for very high risk at admission. RTP was defined as any management tactic other than emergency (&lt;2 h) ICA. Ongoing myocardial ischaemia (OMI) was defined as a combination of ongoing or recurrent chest pain and\/or dyspnoea, along with at least one additional established very high-risk criterion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      RTP was identified in 213 cases (62.6%). There was no adverse effect of RTP on in-hospital mortality [14%\n                      <jats:italic>vs.<\/jats:italic>\n                      10% in the RTP group, P = 0.34, odds ratio (OR) 0.708; 95% confidence interval (CI) 0.36\u20131.37] or on the incidence of long-term major adverse coronary events (MACE). An independent predictor of adverse outcomes was evidence of OMI at hospital admission. Signs of OMI were observed in 168 patients (49.4%). In this subgroup, failure to perform emergency invasive coronary angiography was associated with a higher incidence of MACE during the three-year follow up (29%\n                      <jats:italic>vs.<\/jats:italic>\n                      47.5% in the RTP group, P=0.02, OR 2.2; 95% CI 1.0\u20134.5).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretations and conclusions<\/jats:title>\n                    <jats:p>There was no significant effect of risk-treatment paradox on outcomes in very high-risk patients. Patients with signs of ongoing myocardial ischaemia benefit most from undergoing emergency invasive coronary angiography with the intention of performing percutaneous coronary intervention within two hours.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/ijmr_1781_2025","type":"journal-article","created":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T16:26:04Z","timestamp":1772382364000},"page":"55-61","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of the risk-treatment paradox on in-hospital and long-term outcomes in patients with very high-risk non-ST-elevation acute coronary syndrome"],"prefix":"10.25259","volume":"163","author":[{"given":"Anastasiia","family":"Nesova","sequence":"first","affiliation":[{"name":"Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian 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syndrome","volume":"12","author":"D\u00edez-Villanueva","year":"2024","journal-title":"Biomedicines."},{"key":"10.25259\/IJMR_1781_2025\/ref-2","doi-asserted-by":"crossref","first-page":"88","DOI":"10.29001\/2073-8552-2017-32-3-88-94","article-title":"Approaches to diagnosis and treatment of patients with non-Stsegment elevation acute coronary syndrome in Russian hospitals record-3 registry data","volume":"32","author":"Barbarash","year":"2017","journal-title":"Sib med \u017e (Tomsk)."},{"key":"10.25259\/IJMR_1781_2025\/ref-3","doi-asserted-by":"publisher","first-page":"B3","DOI":"10.1093\/eurheartjsupp\/suac001","article-title":"Patient characteristics, treatment strategy, outcomes, and hospital costs of acute coronary syndrome: 3 years of data from a large high-volume centre in Central Europe","volume":"24","author":"Tou\u0161ek","year":"2022","journal-title":"Eur Heart J 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Iraq","volume":"21","author":"Dakhil","year":"2021","journal-title":"BMC Health Serv Res."},{"key":"10.25259\/IJMR_1781_2025\/ref-10","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1007\/s12471-018-1212-3","article-title":"Use, timing and outcome of coronary angiography in patients with high\u2013risk non\u2013ST\u2013segment elevation acute coronary syndrome in daily clinical practice: Insights from a \u2018real world\u2019 prospective registry","volume":"27","author":"Badings","year":"2019","journal-title":"Neth Heart J."},{"key":"10.25259\/IJMR_1781_2025\/ref-11","doi-asserted-by":"publisher","first-page":"807","DOI":"10.26599\/1671-5411.2024.08.003","article-title":"Optimal timing of invasive intervention for high\u2013risk non\u2013ST\u2013segment\u2013elevation myocardial infarction patients","volume":"21","author":"Zheng","year":"2024","journal-title":"J Geriatr Cardiol."},{"key":"10.25259\/IJMR_1781_2025\/ref-13","doi-asserted-by":"publisher","first-page":"3148","DOI":"10.1093\/eurheartj\/ehac213","article-title":"Timing of invasive strategy in non\u2013ST\u2013elevation acute coronary syndrome: A meta\u2013analysis of randomized controlled trials","volume":"43","author":"Kite","year":"2022","journal-title":"Eur Heart J."},{"key":"10.25259\/IJMR_1781_2025\/ref-14","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1177\/2048872617720929","article-title":"Incidence, treatment strategies and outcomes of acute coronary syndrome with and without ongoing myocardial ischaemia: Results from the CZECH\u20133 registry","volume":"8","author":"Tousek","year":"2019","journal-title":"European Heart Journal: Acute Cardiovascular Care."},{"key":"10.25259\/IJMR_1781_2025\/ref-15","doi-asserted-by":"crossref","first-page":"B10","DOI":"10.1093\/eurheartj\/sux043","article-title":"Timing of intervention in non\u2013ST segment elevation myocardial infarction","volume":"20","author":"Banning","year":"2018","journal-title":"Eur Heart J Suppl."},{"key":"10.25259\/IJMR_1781_2025\/ref-16","doi-asserted-by":"publisher","first-page":"CD004815","DOI":"10.1002\/14651858.CD004815.pub4","article-title":"Routine invasive strategies versus selective invasive strategies for unstable angina and non\u2013ST elevation myocardial infarction in the stent era","volume":"2016","author":"Fanning","year":"2016","journal-title":"Cochrane Database Syst Rev."}],"container-title":["The Indian Journal of Medical 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